Many clinical quality measures required by the Centers for Medicare & Medicaid Services remain "process oriented" and not based on patient outcomes, and thus are not conducive to the implementation of alternative payment models, according to the College of Healthcare Information Management Executives (CHIME).
In a letter to CMS Acting Administrator Andy Slavitt, CHIME President and CEO Russell Branzell and Board Chair Marc Probst, who also serves as CIO for Intermountain Healthcare, say the discrepancy not only costs hospitals "millions of dollars" in lost incentives, but also makes having to capture and report true quality data more burdensome for providers.
They also call the frequency of change for electronic clinical quality measures "a significant issue" for hospital CIOs, noting that at least one CIO had to hire a full-time equivalent employee just to keep up with all of the necessary upgrades.
"This also places a big burden on the vendors," Branzell and Probst say. "We are also hearing concerns about scenarios where a vendor decides they are no longer able to keep up with the pace of changes being required."
Because of that, CHIME calls for a more "predictable" cycle regarding eCQM changes in which a timeline is developed. Instead of setting specific deadlines, once a task on the timeline is completed, the remaining tasks will shift over "rather than adhering to an unrealistic deadline," Branzell and Probst say.
CHIME also calls for alignment of reporting requirements between both CMS and private payers, saying that its members "would like to see ... a single set of quality measures" identified by the federal government that the states and private payers agree on. CMS, on Tuesday, announced a plan to align core measures for quality-based payments with America's Health Insurance Plans.
In addition, CHIME proposes:
- A requirement that vendors certify to all eCQMs
- Development of a testing process that's less "sterile" and more "reflective of real-life clinical scenarios"
"Products tested in a controlled environment do not reflect how well they will perform in a real-word clinical setting," Branzell and Probst say. "In actuality, providers are grappling with scenarios where, once the software is installed, systems are getting suspended and tremendous time and resources are being devoted to fixing the system, creating an overall cumbersome process and drain on resources."
In a letter to Slavitt earlier this month, the American Medical Informatics Association (AMIA) criticizes CMS' focus on enhanced certification, saying it does not address fundamental deficiencies and challenges with generating eCQMs and reporting them. AMIA President and CEO Doug Fridsma and Thomas Payne, M.D., AMIA board chair and director of IT services at University of Washington Medicine, say the task "overshadows" any benefit the eCQMs provide.
"This focus on certification is therefore problematic because it suggests a view that certification enhancements are a promising way to address the problems with quality measurement that have emerged and we do not believe this is the case," they say. "Providers have very little confidence in eCQM accuracy and completeness; health IT developers spend an inordinate amount of resources devoted to eCQMs, which presents an opportunity cost for other costumer priorities; and there is little time for the stakeholders to incorporate updates into their products and workflows."
CHIME, in its letter, says it takes roughly 24 months for a vendor to make, and for providers to deploy, updates to a product--18 months for the former task, and six months for the latter.
To learn more:
- read CHIME's letter to Slavitt (.pdf)
- check out the CMS announcement